Healthcare Provider Details

I. General information

NPI: 1649786955
Provider Name (Legal Business Name): ANN LORRAINE BROOKS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEW STATE HWY
RAYNHAM MA
02767-5423
US

IV. Provider business mailing address

100 NEW STATE HWY
RAYNHAM MA
02767-5423
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 781-666-2711
  • Fax: 781-666-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14097
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120300
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: